1991, 08-15 Permit App: 91005060 Sprinkler Systemm -
PLUMBING PERMIT APPLICATION FORM
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Information Worksheet r
JOB STREET ADDRESS:.?/E-
CITY/STATE/ZIP- PARCEL NUMBER:
OWNER: V I PHONE NUMBER:
MAILING ADDRESS:
(Street) (City/State) (Zip)
CONTRACTOR: LICENSE NUMBER:
PHONE NUMBER:
MAILING ADDR
(Street) (City/State)- (Zip)
PLUMBING WORKSHEET/FEE SCHEDULE
DESCRIPTION
TOILETS
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St
SHOWERS
KITCHEN SINKS
GARBAGE DISPOSAL
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:+S::r:.v.•:{•hi{n..-.ri:{:-Si::i.-:.:•:.•,.::�:-:S%i.:�:•::i{`•:ii h`t{{':: a.:......... St::G4N��:{v`{•}::IX-:::::.+-:::...... ::.h-:'.
UTILITY SINKS
E ..E
..FLOOR DRAINS:.;;:-:.:.:;...........................................................................:..........
BAR SINKS
-LAWN SPRINKLER
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WATER SOFTENER
........................................... ..................
.............................................................................................
......................................................................
<UR..NAL.......:.....:....:.::_:::.._..:...:..:_.:+...:::..:.:.:....:..:.:::...:::....,:......:....:.:....::......:..::::..
............................................................................................................................................
DRINKING FOUNTAIN::::..........................................................................
NOTE: MINIMUM PERMIT FEE IS $35.00
SIGNATURE
NUMBER
OF UNITS
X EACH
UNIT
=AMOUNT
x 6.00 =
.X 6.00 =
x 6.00 =
x 6.00 =
x 6.00.
x 6.00
x 6.00 —
x 6.00
x6.00=
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 _
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
x 6.00 =
;r.
SUBTOTAL
$
PLUS: PROCESSING FEE
+$ 25.00
EQUALS: TOTAL PERMIT
FEE DUE
=$
Spokane County Division of Buildings
West 1303 Broadway Avenue Spokane, WA 99260 (509) 456-3675